The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

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Fatigued recreational athletes demonstrate altered motor control strategies, which may increase anterior tibial shear force, strain on the anterior cruciate ligament, and risk of injury for both female and male subjects. CLINIC RELEVANCE: Fatigued athletes may have an increased risk of noncontact anterior cruciate ligament injury.

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In soccer one of the most common knee injuries is the anterior cruciate ligament (ACL) tear, which usually occurs through non-contact mechanisms. Female soccer players are at higher risk of sustaining non-contact ACL injuries than male soccer players. A good understanding of ACL loading mechanisms is the basis for a good understanding of the mechanisms of non-contact ACL injuries, which in turn is essential for identifying risk factors and developing prevention strategies. Current literature demonstrates that sagittal plane biomechanical factors, such as small knee flexion angle, great posterior ground reaction force and great quadriceps muscle force, are the major ACL loading mechanisms. A great posterior ground reaction force may be associated with a great quadriceps muscle force, which would cause great anterior draw force at the knee. A small knee flexion is associated with a large patella tendon-tibia shaft angle and ACL elevation angle, which would result in great ACL loading. Current literature also demonstrates that the ACL is not the major structure of bearing knee valgus-varus moment and internal-external rotation loadings. Knee valgus-varus moment and internal-external rotation moment alone are not likely to result in isolated ACL injuries without injuring other knee structures.A nterior cruciate ligament (ACL) injury is one of the most commonly seen injuries in sport and has a devastating influence on patients' activity levels and quality of life. Gottlob et al 21 estimated that approximately 175 000 primary ACL reconstruction surgeries were performed annually in the USA with an estimated cost of over US$2 billion. Complete ACL rupture can induce other pathological knee conditions including knee instability, damage to menisci and the chondral surface, and osteoarthritis. Studies have repeatedly shown that patients with complete ACL rupture have chronic knee instability and secondary damage to menisci and chondral surfaces.19 28 30 ACL injuries that occur without physical contact between athletes are referred to as non-contact ACL injuries 8 17 18 and most occur through a non-contact mechanism of injury in sports in which sudden deceleration, landing and pivoting manoeuvres are repeatedly performed.8 Female athletes had a higher incidence of ACL injuries compared with their male counterparts.2 18 Studies have shown that the incidence in female athletes is two to eight times higher than in males in soccer, basketball and volleyball. As with other sports injuries, understanding injury mechanisms is a key component of preventing non-contact ACL injuries. 36a The research effort to determine the risk factors for sustaining non-contact ACL injuries is increasing as concerns grow about the larger number of incidents, the greater treatment costs and the serious consequences of non-contact ACL injuries. Prospective cohort studies commonly use epidemiological research designs for determining injury and disease risk factors, 48 and are being used for determining the risk factors for sustaining non-contact ACL ...